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(J. Scott Applewhite / AP)

There's a lot of uncertainty about how the Congressional Budget Office will estimate the costs of the GOP health care bill the House passed earlier this month. But one thing that's almost certain: It won't change its estimate that 14 million people will lose their Medicaid coverage.

That's because the House didn't change the bill's Medicaid provisions since CBO analyzed an earlier version of the bill. It makes significant cuts to the program, which will knock millions of people off their coverage. It then pairs these cuts with tax credits for those on the individual market, which fall well short of what very low-income people need to afford insurance, experts say.

What we're watching: Whether the Senate shores up the tax credits enough to put coverage within reach of people near the poverty line and helps with their other costs. If it doesn't, coverage will remain out of reach for the poor.

The House made other changes to the bill, including state waivers that could affect private health insurance. But the two main reasons for the Medicaid coverage losses haven't changed: The bill phases out the Affordable Care Act's expansion of the program, and it limits how much federal funding each enrollee gets.

And because the bill's tax credits wouldn't adjust for income, "there's just no way most people at or near poverty now eligible for Medicaid could afford to buy even a high deductible plan in the individual market," Larry Levitt, vice president of the Kaiser Family Foundation, told me.

What you need to know:

  • Both CBO and Medicaid experts predict that many states that expanded Medicaid — if not most — would drop the expansion of the program, because they wouldn't be able to afford it after federal funds are scaled back.
  • If that happens, the best option for people who just gained Medicaid coverage would be the individual market, where tax credits are offered based on age and vary between $2,000 and $4,000.
  • The House bill does not provide any kind of help for deductibles or out-of-pocket costs for low-income people, like the ACA does.
  • A $130 billion fund might help states reduce premiums, but probably not enough. And most of the money probably would be used to help sick people, not low-income people.

Here's an example, per the Brooking Institution's Matthew Fiedler:

  • A 45-year-old at 75 percent of the poverty line — currently eligible for Medicaid in an expansion state — would make around $9,500 in 2020.
  • An average "silver" plan, which is often used as a benchmark, would likely cost around $5,500 by 2020. The House bill's tax credit would cover $3,000 of this.
  • So this person would still be on the hook for $2,500 of the premium, which is more than a quarter of his or her income.
  • "Few would purchase insurance under such conditions," Fiedler told me.

Go deeper

3 hours ago - Health

5 times as many police officers have died from COVID as from guns since pandemic began

Photo: Genaro Molina / Los Angeles Times via Getty Images

COVID-19 is the leading cause of death for police officers even though members of law enforcement were among the first to be eligible to receive the vaccine, CNN reports, citing data from the Officer Down Memorial Page.

Why it matters: Nearly 476 police officers have died of COVID-19 since the pandemic started, compared to the 93 deaths as a result of gunfire in the same time period, according to ODMP and CNN.

Virginia energy giant quietly boosts McAuliffe

Former Virginia Gov. Terry McAuliffe speaks during a campaign rally on Oct. 15 in Henrico, Virginia. Photo: Win McNamee/Getty Images

Virginia Democrat Terry McAuliffe has sworn off money from the Richmond company Dominion Energy. But the utility has found more subtle ways to back McAuliffe's gubernatorial bid, records show.

Driving the news: Dominion's political action committee has donated $200,000 to a murky political group called Accountability Virginia PAC, a group with ties to prominent Democrats that's been running ads attacking Republican candidate Glenn Youngkin from the right.

5 hours ago - Technology

Race and technology in America

Illustration: Annelise Capossela/Axios

The technology industry is famously determined to change the world — but its efforts to diversify its workforce and remove bias from its products haven't changed nearly enough.